Individual
MUAD KHALLAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 970-4091
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 970-4091
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MRM-2190
ID
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MRM-2190
IDAHO BOARD OF MEDICINE
ID
Enumeration date
05/23/2022
Last updated
07/03/2024
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